All right this is a presentation on the adverse effects of anti-psychotic medication so first of all going into what are the basic uses of antipsychotic medications and of course we’ve heard from that with these – like schizophrenia or schizophrenics form its orders affective disorder or delusional disorder or brief psychotic disorder just a couple of uses
Of antipsychotic medications there is a journal article that this is roughly based on visited here it talks about the management of common adverse effects of psychotic medications i’m going to try to present the material from that from numbers and resources which i listed my references at the end so kind of as a as a game everybody could take a piece of paper
Really quickly and jot down as many antipsychotic agents medications that you can think of and whoever gets the most don’t look anything up and look at your phone so if you don’t like your computers just rip write down as many as you can from memory every gets the most is going to be the winner some prize for you take a moment jot all those down all right when
You’re done go ahead and total those up anybody get three anybody get four five six seven i’m gonna get more than that okay so here’s a list you can kind of check if or maybes you go there’s actually even more than this but here’s a few so what are the divisions of antipsychotics basically they divide them into first-generation massicotte x and then a typical or
Second-generation antipsychotics and here are some of them listed so you’re much more familiar with these ones over these ones so with these first jet first-generation or atypical antipsychotic second generation if you were to add up how many first generations who listed versus how many second generations making solicit listed you notice that you have a lot more
Second generation ones listed why is that because well you’re more familiar with the second generation ones so which one is more effective in the treatment of cognitive and negative symptoms of schizophrenia this is a trick question there is no evidence that second-generation antipsychotics are significantly more effective than first generation antipsychotics in
The treatment of cognitive and negative symptoms of schizophrenia so why do we use one more than the other what’s the difference the difference is found and that the first generation antipsychotics versus the second generation have a higher risk of extrapyramidal symptoms they’re primarily the d2 antagonists second generations are d2 antagonists as well but they’re
Also 5ht 2a antagonists but they’re associated with lower risks of extrapyramidal symptoms and they are however associated with a higher risk of metabolic side effects so talking i want to talk about some autonomic side effects here is it kind of from it with them this is be kind of a fun quiz to test our knowledge here so if muscarinic cholinergic blockade or alpha
Adrenergic blockade and these are mostly more associated with the agents that are gonna try to reverse these but let’s go through these real quickly so dry mouth is which one is a muscarinic or adrenergic that’s correct okay what about impaired dracul asian that is alpha adrenergic what about constipation musker my scanner muscarinic what about cyclo please yeah
It’s muscarinic what about orthostatic hypotension paginate urinary retention muscarinic delirium is quranic’ impotence a genetic about mydriasis it’s muscarinic alright so because these extra criminal symptoms these were some references used for some of these who has seen extrapyramidal extrapyramidal symptoms before let me tell some stories here anybody like
To share a story is free to do so why was it caused what caused the person to have these extrapyramidal symptoms and lastly what did you do about it doesn’t remember what they did and did it work share some stories here and talk about it okay so let’s talk about it really quickly the mechanism of these extra prim ”’l symptoms so parts of the brain associated with
This is the substantia in the basal ganglia essentially really basically you have you know this dopamine being blocked or antagonized and so you basically have more acetylcholine activity because you more acetylcholine activity you get this presentation so it’s relative dopamine deficiency in the negative strap athlei so in parkinson’s disease is different than
In with antipsychotics with the antipsychotics you get a blockade of d2 receptors in the night but struggle pathway whereas in parkinson’s disease you get a loss the dopinder dopaminergic neurons and parts compactive substantia so the management of antipsychotic induced parkinsonism way to do this is you have a dose reduction of anti-psychotic agent anticholinergic
Agents that you can use our tri-axial fenna dil bends tropane which is the one that i see we see most often on the crescentin there’s also by paradin and apparently o’connell sieves amantadine for this so adverse effects of anticholinergic agents after you give these things to treat it seems you can have these central and peripheral effects the cognitive impairment
Delirium hyperthermia peripheral dry mouth blurred vision glaucoma constipation ileus kinds of things let’s move on to dystonia now so with dystonia you have the adverse reaction to antipsychotic medications so you give someone medication for so i guess who who is had a patient from this anybody i like to share a story all right and what did you do about it and
Did it work good so again this is adverse reactions antipsychotic medications it’s a sudden sustained involuntary muscle spasm and it may occur in any muscle group most commonly though it’s in the head and neck can also be the eyes the neck throat jaw each one of these has different names the jobs to trismus throat aschler ninja spasm that goes toward colas eyes
Is oculogyric crisis so what are the risk factors for this i mean typically it’s gonna be the medication that’s being given if you’re giving a high potency first generation antipsychotic it’s gonna be the highest risk if you use a low potency first generation now it’s got like it’s gonna be lower risk the most potent of the second generations like risperidone
Pilot perdón it can happen but it’s very rare and then the less potent ones like air peppers all these ones atlanta pains a president it’s even more rare but it can still happen quetiapine clozapine i mean theoretically maybe it can happen but apparently it’s not been reported so some of the risk factors for this is gonna usually be the timing and the dose so it’s
Usually early in treatment the dystonia so it’s gonna be the first five days it’s gonna be the rapidly increasing dose and it’s gonna be a trough serum level it’s usually when it occurs so when they’re in the trough oddly enough so if you go up really quickly and then they get in different kind of between the doses in the trough flow that’s when they usually have it
Early on so other risk factors apparently is large muscle mass younger people and being male so that being said it means that a low muscle mass older woman would be a would be a more safe patient as far as dystonia is involved so the diagnosis usually it’s early in antipsychotic treatment sudden onset localized to one or more or a few muscle groups no alteration
Consciousness and no alteration in vital signs if you see that it’s probably gonna be dystonia so what do you do somebody’s got this estonia she may have mentioned earlier in your stories an anticholinergic such as been strobing cinemascore agenda in 2 milligrams imq 15 30 minutes up to 8 milligrams or you can use some these other options like tri-axial fin adel
Or you can use antihistamine like diphenhydramine benadryl 50 milligrams imq 15 30 minutes up to 200 milligrams so takeaway points from this acute dystonic reaction its associated with antipsychotics especially high potency first generation antipsychotics and appears mostly in early treatment the management again these medications we just went over those are kind
Of the key takeaways for dystonia let’s talk about tardive dyskinesia for a minute so i was the where this information was taken from so this is kind of can be recognized these uncontrollable movements of the trunk or hips like rocking jerking flexing thrust eat uncontrolled movements of the tongue jar lips dancing movements of the fingers or toes like writhing or
Twisting and this is a more real a delayed reaction so it’s not gonna be something that happens alright first it was a pretty good video we could watch about this let’s go ahead and bring this up for a minute well if you’d like to see if there it is so lastly just kind of comparing these different things there’s pseudo parkinsonism the stooped posture shuffling gait
Rigidity brady kinesia i really like this tiger i’m just gonna show it all tremors at rest pill rolling motion of the hand let’s look as opposed to the acute dystonia facial grandma seen involuntary upward eye movements muscle spasm of the tongue neck face back back muscle spasm skies cause trunk to arch forward or laryngeal spasm they cathedrals to the restless
Trouble staying still paces the floor feet in constant motion rocking back and forth and the tardive dyskinesia was the protrusion and rolling of the tongue sucking smacking movements ellipse chin motion facial dyskinesia and involuntary movements of the body and extremities so this image didn’t come out very well but there’s also the metabolic side effects that
Come especially with which one was it was the first generation or the second generation the typical of a tipple more common with the atypical because the five serotonin 5 2 h forgotten the the well anyway yeah so more associated with the other thing where the one is just opening their the – the v 2 h 1 so let’s see where was i here we go so some of the ones that
Cause more of this metabolic side effect looks like they’re it’s more clozapine olanzapine less so or spero don’t quite tight beam and then the ones that come the bottom list are gonna be there papers all onset president and again the higher risk weight gain is the higher risk of diabetes and dyslipidemia okay so the last one is the prolactin elevation which can
Cause gynecomastia which is another side effect when you block the dopamine so other side effects of his medication lugli seizures orthostatic hypotension or leptin lignan syndrome qt prolongation sudden death death anticholinergic effects sedation myocarditis agranulocytosis the agranulocytosis myocarditis i believe is mostly associated with the clozapine here’s
Kind of a comparative chart kind of showing there’s just a lot more data out there are different ones are worse at certain side effects and so you can kind of choose this based on your patient and what they present whether what they’re concerned about so just kind of demonstrating these here that the data is out there you can go back and look at later if you want
To or make comments so the relative adverse effect incidents of antipsychotics again kind of comparing these with court promazine and thyroid is een against those those are first-generation and then kind of checking the other this is that the typical low potency reciprocal high potency ones and then you got the atypicals down there kind of showing you know the
Different risks here for sedation extrapyramidal symptoms anticholinergic or the stasis seizures see how most of these are low here and then especially with the prolactin elevation these are these are pretty low compared to compared to the other ones this is my references and that’s the end
Transcribed from video
Anti-psychotic Medication side effects and management By Richard Wadsworth
